You have a right to file a grievance

 

If you are unhappy with anything about Molina or its providers, you should contact us as soon as possible. You, or someone you want to speak for you, can contact us. If you want someone to speak for you, you will need to let us know this. Molina wants you to contact us so that we can help you.

A grievance is an expression of dissatisfaction about any matter other than an adverse benefit determination (a decision not made in your favor).

 An adverse benefit determination (a decision not made in your favor) can be:

• Limiting or denying services;

• Reducing services;

• Suspending services;

• Terminating services;

• Denying payment for services;

• Failing to provide services in a timely manner;

• Failing to resolve appeals and grievances within timeliness guidelines;

• For a resident of a rural area with only one Managed Care Organization in the area, the denial of a request to exercise his or her right to get services outside the Molina network; or

• The denial of a request to dispute a financial responsibility, including cost sharing, copays, premiums, deductibles, coinsurance, and other member financial responsibilities.

 

Examples of grievances include:

• Not being able to find a doctor;

• Trouble getting an appointment; or

• Not being treated fairly by someone who works at Molina or at your doctor’s office.

 

If you are dissatisfied, you or a person you choose and name, such as an attorney or provider, may file a formal complaint or grievance orally by contacting us at (855) 882-3901. Molina needs your permission in writing for someone else to file a grievance for you. You may also file a complaint in writing. A grievance may be filed at any time. If you need an interpreter to talk to us in another language, you can ask for one by calling Member Services.

To file a grievance, you can:

 

Mail the letter or form to:

Molina Healthcare of South Carolina

C/O Firstsource

PO Box182273

Chattanooga, TN 37422

 

Phone: (855) 882-3901

You can also fax the letter or form to  (877) 823-5961, Attn: Member Appeals & Grievances.

 

If you are sending us a letter about your grievance or completing the form, you should include:

  • Date
  • Your first and last name
  • Your address and telephone number
  • Your email address
  • Your Molina Member ID number, which is on the front of your Member ID Card
  • Description of the issue
  • Your signature

 

When you file a grievance, we will let you know we received it within 5 business days. We will resolve your grievance as quickly as possible, but no later than 90 calendar days from the day Molina receives your grievance.

You can ask Molina to extend the timeframe to resolve your grievance by up to 14 calendar days. Molina can also extend the timeframe to resolve your grievance by up to 14 calendar days if Molina thinks that the delay is in your best interest. If Molina extends the timeframe, we must be able to explain to SCDHHS how the delay is in your best interest. We will call you and a letter will be sent to you informing you of the extension and why the delay is in your best interest. If Molina extends the timeframe, the letter will also include information about your right to file a grievance about extending the timeframe.

 If you would like a copy of our official grievance procedure or if you need help filing a grievance, please call (855) 882-3901 or visit molinahealthcare.com/sc to print a copy of the Member Grievance Request form. If you are hard of hearing, call our TTY line. It may take time; please do not hang up.